Changes in retail food environments around schools over 12 years in Flanders, Belgium

Abstract Background Food environments influence food preferences, in particular among children. Besides their homes, children spend most of their time in and around the school. This study mapped changes in retail food environments around primary and secondary schools in Flanders between 2008 and 2020. In addition, associations between those indicators and children's weight status were assessed. Methods The food environment near primary and secondary schools was mapped using three spatial indicators: 1) The density of different types of food retailers within 1000m road distance from the school entrance, 2) the percentage of schools with at least one food retailer of a certain type within 1000m road distance from the entrance, and 3) the median walking distance from the school entrance to the nearest food retailer of a certain type. Associations between the density of convenience stores, as well as fast food outlets around the schools and the weight status of the schools’ children were assessed using generalized linear models adjusted for level of urbanization, socio-economic status of children at school level and sex. Results Food environments near schools in Flanders were found to be unhealthy, with a significant increase in fast-food outlets and convenience stores between 2008 and 2020. Food environments near schools with a higher proportion of children from a poor socio-economic background were found more unhealthy than those near schools with a lower proportion of such children, regardless of the urbanization level. A significant positive association was found between the density of fast food outlets as well as convenience stores around primary schools and the weight status of children aged <6 years and 6-12 years. Conclusions Food environments around schools in Flanders became more unhealthy over time and were associated with children's weight status. The government therefor has the responsibility to create healthy food environments near schools to protect children's health. Key messages • The food environment near schools became more unhealthy between 2008 and 2020. • The food environment near schools was associated with younger children's weight status.


Background:
British children have the highest ultra-processed food (UPF) intake in Europe, which is linked to adverse health outcomes. Schools are posited as a setting for dietary intervention, yet the level of UPFs consumed at schools is currently unknown. This study aimed to describe the UPF content of school food in the UK, explore the UPF content of school meals and packed lunches (food from home) and examine whether UPF differs by children's household income.

Methods:
A pooled cross-sectional analysis of primary (4-11 years, n = 1,895) and secondary schoolchildren (11-18 years, n = 1,408) from the UK's National Diet andNutrition Survey (2008-2017) was conducted. Food diaries recorded student's meal-type (school meal/packed lunch). UPF intake was defined using the NOVA food classification system. Quantile regression models assessed the association between meal-type and lunchtime UPF intake (%kcal and % grams). Models were stratified by school phase (primary/secondary) and interacted meal-type with income.

Results:
Schoolchildren consumed most of their lunch as UPF, with higher median intakes in secondary schoolchildren than primary schoolchildren (77.8 %kcal vs 72.6 %kcal). School meals were associated with lower median UPF intake (%kcal) in both primary (-20 percentage-points[pp] [95% ) and secondary schoolchildren (-11pp [-16.0,-7.0]) compared with packed lunches. Results were similar when UPF %g was analysed. Overall, income was inversely associated with UPF content. However, in primary schoolchildren there was no significant income gradient in the UPF(%g) content of school meals.

Conclusions:
In the first nationally representative study, we showed that on average UPF intake was high in all UK schoolchildren. Higher UPF intakes were observed in packed lunch consumers, secondary schoolchildren, and those with a lower income. Procurement policies must be revaluated to protect children from high UPF intake. Funders: NIHR School for Public Health Research Key messages: In the first study of ultra-processed food content of UK school food, we show that children consumed around three quarters of their energy as ultra-processed food at lunch. Children who were older, took food from home or were from a low-income household were more likely to consume higher levels of ultra-processed food. Regulation is needed to protect these children.

Background:
Food environments influence food preferences, in particular among children. Besides their homes, children spend most of their time in and around the school. This study mapped changes in retail food environments around primary and secondary schools in Flanders between 2008 and 2020. In addition, associations between those indicators and children's weight status were assessed.

Methods:
The food environment near primary and secondary schools was mapped using three spatial indicators: 1) The density of different types of food retailers within 1000m road distance from the school entrance, 2) the percentage of schools with at least one food retailer of a certain type within 1000m road distance from the entrance, and 3) the median walking distance from the school entrance to the nearest food retailer of a certain type. Associations between the density of convenience stores, as well as fast food outlets around the schools and the weight status of the schools' children were assessed using generalized linear models adjusted for level of urbanization, socio-economic status of children at school level and sex.

Results:
Food environments near schools in Flanders were found to be unhealthy, with a significant increase in fast-food outlets and convenience stores between 2008 and 2020. Food environments near schools with a higher proportion of children from a poor socio-economic background were found more unhealthy than those near schools with a lower proportion of such children, regardless of the urbanization level. A significant positive association was found between the density of fast food outlets as well as convenience stores around

Background:
Maternal health remains a major issue of concern in Sierra Leone. In the main referral maternity institution, Princess Christian Maternity Hospital (PCMH), up to 25% of maternal deaths occur during or shortly after transit from another health facility. There is an urgent need to improve referral systems between peripheral health units (PHUs) and PCMH.
Our aim was to pilot and evaluate an eHealth tool facilitating referral of obstetric emergency cases through effective teleconsultation between PHUs and PCMH.

Methods:
A web application was designed to capture unclear or complicated delivery cases at PHUs and request respective telemedical counselling from the referral institution PCMH. The eHealth tool was piloted at 10 PHUs in Western area urban and rural in August 2021. Necessary devices were provided and delivery staff was trained to use the app. In December 2021, we conducted focus group discussion with 3-6 delivery staff at five PHUs and at PCMH to evaluate utilization and outcomes of the tool.

Results:
All participants perceived the eHealth tool as an improvement of referral procedures. Response time from PCMH after a request for counselling from a PHU was mostly <30 minutes. The main perceived advantage of the tool was the systematic documentation of obstetric complications and procedures. This relieved staff from fear of wrong treatment accusations, and recorded communication with PCMH made processes and responsibilities transparent. Another important benefit was PCMH staff being already prepared to receive a specific emergency case after use of the app, thus reducing the 'third delay' within the referral facility. As a major obstacle to smooth referral despite the eHealth tool, a lacking ambulance system was mentioned as a critical gap.

Conclusions:
Exceedingly positive user experiences with this simple tool seem to make an expansion to more PHUs worthwhile. Benefits of using the app in more remote districts in Sierra Leone should be further investigated.
Key messages: Delivery staff in Sierra Leone was capable of using a web app for telemedical counselling in a useful and effective manner.
The eHealth tool was perceived as very helpful in systematically and transparently documenting emergency delivery cases and treatment procedures.

Background:
IMMUNI is an app that was created to help fight epidemics, starting with COVID-19. The app has a contact tracing feature but its diffusion in Italy was low. In this pilot study, we investigated university students' attitudes and experience towards the IMMUNI app.

Methods:
This cross-sectional study was conducted at Sapienza University of Rome between 14 April and 19 April 2021. An online survey was administrated to university students of medical area. A multivariable logistic regression model was built to identify app download's predictors. Adjusted odds ratio (aOR) and 95% confidence interval (CI) were calculated.

Results:
We collected 247 questionnaires (response rate: 78.2%). More than half of the students (65.0%) didn't download IMMUNI app mostly because of the belief that it was useless (30.0%). By contrast, the main reason for downloading was sense of duty (40.0%). Experience with the app was limited but the process was judged as lacking for the technical difficulties. As for hypothetical incentives, feedback on how the download could help against the pandemic was considered as the most effective (3.5 out of 5). In the multivariable analysis, higher likelihood of download was associated with higher fear of contagion for family and acquaintances (aOR:1.50, 95% CI: 1.01-2.23) and higher rating to the health management of the emergency (aOR: 1.33, 95% CI:1.00-1.76). The highest odds of download were found for participants who have been advised to download the app (aOR: 3.21, 95% CI:1.80-5.73). On the other hand, greater belief that the virus came from a laboratory was negatively associated with the download (aOR: 0.75, 95% CI: 0.60-0.93).

Conclusions:
Strategies aimed at raising students' awareness on the importance of health technologies, restoring confidence in health authorities, and limiting disinformation around SARS-Cov-2 should be devised. In addition, the app could be enriched with positive feedbacks for users, and some technical issues should be fixed.